Uganda: Lessons From Uganda's Aids Success Story

Uganda has become Africa's HIV/Aids success story but critics say many
claims have been predicated on selective pieces of information.

However, one critic and Aids researcher, Justin O Parkhurst, says
although there are big holes in Uganda's HIV/Aids story, all available
evidence shows that the country has successfully managed to prevent the
spread of HIV-1 in many ways. He says there are meaningful lessons to be
learnt from the way the Ugandan government and other institutions have
tackled the deadly disease.

"However, the importance of the Ugandan experience will be compromised
if conclusions are drawn out of context and statements are made on the basis
of oversimplified assessment of epidemiological data," Parkhurst wrote in
the medical journal, The Lancet, early this year. According to a study by a
Harvard University intern Sarah Trafford, promotion of abstinence through
billboards, radio programmes and school sex education curricula, has
resulted in a slow and steady drop in HIV infection rates, as well as new
attitudes about conquering Aids in Uganda. Uganda has also successfully
introduced the anti-retroviral (ARV) therapy or treatment of people with
HIV/Aids.

Ugandan doctor Dickson Opul, who spoke at a recent one-day regional
symposium on Access to HIV/Aids Treatment, gave an insight into the success
of the programme. Dr Opul is the chairman of the Uganda Business Coalition
on HIV/Aids secretariat and has worked as a country representative for an
international company introducing anti-retroviral drugs to the Ugandan
market. He has also worked as an African regional advisor for the Aids
Health Care Foundation where he developed model Aids treatment centres to
provide anti-retroviral therapy to the most needy and poorest countries in
Africa. After his presentation on how people's lives can be saved by ARVs,
one could not help feel that many Zimbabweans have died and continue to die
needlessly from Aids because they have no access to drugs that could
otherwise prolong their existence.

Dr Opul says Uganda's population is about 24 million with 84 percent
living in the rural settings and over 1,5 million infected with HIV. "One
million Ugandans have perished due to Aids since the first case was reported
in 1983. Uganda has close to 1,5 million orphans due primarily to
Aids. Close to 90 000 new HIV infections occur each year but national HIV
prevalence has dropped from 30 percent in 1986 to its current level of 6,1
percent (2001)," Opul says. How and why has this happened when in Zimbabwe
HIV/Aids is increasing every day? According to Dr Opul, a multi-sectoral
approach with a strong political leadership and commitment, contributed
enormously to behavioural change and the subsequent drop in HIV
prevalence. "The burden of disease is still very high and it seems the fall
in prevalence may have levelled," he says.

In Uganda it is estimated that between 10 and 20 percent of people
living with HIV (100 000 and 200 000), are in urgent need of anti-retroviral
therapy. Between 4 000 and 10 000 have access to ARV drugs meaning that only
4 percent of the very needy are on therapy. "There is no government subsidy
or financing for ARVs in Uganda. The national ARV policy is not yet in place
although it is under development. The cost of (branded) drugs has
significantly dropped from nearly US$ 1 000 (Z$55 000) a month in 1997/98 to
the present US$60. "Generic drugs are gaining rapid entry with prices of
about US$30 a month. Annual income per capita is US$300 as compared to
$360-$720, the annual cost of ARVs. Nearly 45 percent of Ugandans live on
less than US$1 a day or below the poverty datum line." Opul says it is
unlikely that price reduction strategy alone can significantly increase the
proportion of people living with HIV on ARVs in rural areas.

Dr Opul spoke on the Uganda Cares programme, an experience of
integrating and delivering a comprehensive model of ARV in a rural African
community setting in Masaka district. A partnership of the government and
the private sector, the programme aims at the feasibility of delivering free
highly-active anti-retroviral therapy to the sickest and socio-economically
disadvantaged people living with HIV in rural areas. As one example of
numerous studies carried out in Uganda's Masaka district, 47 people were put
on ARVs and their initial average weight before treatment was 55,30kg. After
3-6 months of therapy the average weight rose to 59,78kg, realising a
percentage weight gain of plus 8,10 percent. Two patients showed a decrease
in body weight of minus 05 to minus 1kg. One patient showed no change in
weight after three months but remained in good health. At least 93,6 percent
of the patients recorded positive weight gain with an average gain of 6,4 kg
after 3-6months of therapy.

Dr Opul says there are numerous challenges to implementing
community-based ARV programmes which include long distances to laboratories
where the CD 4 count (cell count is performed to determine the need for
ARVs) is done, lack of transport, inadequate communication and the high cost
of the drugs. Lessons learnt showed that people in rural settings can adhere
well to ARV medications as shown by 91,5 percent of patients with 100
percent adherence after six months of treatment. Dr Opul says family and
community support through non-governmental organisations are vital for the
success of the programme. "Remarkable and significant improvement in the
quality of life of patients within a short span of time has been shown by
weight gain and immunological recovery. There was no reported stigma
associated with taking ARV medications in the community."

Another Ugandan with first-hand experience of HIV/Aids, is Noerine
Kaleeba who set up The Aids Support Organisation in Uganda. Kaleeba, who
currently works for UNAids, feels very strongly about the stigmatisation of
HIV/Aids patients. "As long as the stigma continues to hang in the air, we
keep away. Naturally, as human beings, we want to protect ourselves from
being associated with HIV/Aids. So we have to address the stigmatisation
issue before anything else." One of the key actions that must be taken to
address the stigma problem, is to care for people with HIV/Aids so that they
become healthy again and go back to work, standing by themselves.

"Once people begin to see them as healthy individuals again, we get rid
of the stigma attached in Africa because this upsets the person or the
family," she says. The treatment of infected people will also help address
the problem of orphans because once a person is treated with ARVs which
Kaleeba stressed are not a cure for HIV/Aids, they will begin to fend for
their families. "My children cannot be orphans when I am healthy and alive
so we must make every effort to provide treatment and stop discussing he
issue of more orphanages," Kaleeba says but acknowledges that the ARV
medicines are not accessible by everybody. But she says that should not be
an excuse as there has to be a start somewhere. "Equity is a debate that
continues. Everything starts with something. Let's give anti-retrovirals to
those who need them most," she says and gives an example of how eight
members in her family - two adults and six children, were infected with
HIV. "I could not afford to buy ARVs for all of them. We made a decision as
a family of who had the most urgent need, so we settled for my brother. It
was an ethical choice we made, so that by treating him, we delayed
orphanhood for his children," she says. At least there is a glimmer of hope
that HIV/Aids patients can survive longer if they can have access to
treatment or complete abstinence on the part of the uninfected and the
unaffected.

AllAfrica publishes around 2,000 reports a day from more than 130 news organizations and over 200 other institutions and individuals, representing a diversity of positions on every topic. We publish news and views ranging from vigorous opponents of governments to government publications and spokespersons. Publishers named above each report are responsible for their own content, which AllAfrica does not have the legal right to edit or correct.

AllAfrica is a voice of, by and about Africa - aggregating, producing and distributing 2000 news and information items daily from over 130 African news organizations and our own reporters to an African and global public. We operate from Cape Town, Dakar, Lagos, Monrovia, Nairobi and Washington DC.